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DS-19-128BUILDING PERMIT APPLICATION Miami Shores Village ✓qy C��v Building Department , F© 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 10J9 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 n CANCELLED Master Permit No.TS I I - ra Sub Permit No. f-JBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL F-IPLUMBING ❑ MECHANICAL PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami S-hore�s County: Miami Dade Zip: . Folio/Parcel#: 0;e)(O Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee ��Simple Titleholder): Address: , �V ol City: SPA QCA.AL.A State: [--L- Zip: Tenant/Lessee Name: Phone#: Email �� CONTRACTOR: Company Name: Addressi ick 9 no City: 19 Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zjp: V (� Value of Work for this Permit: $ 1!5 Square/Linear Footage of Work.1 I tsoC7 Type of Work: ❑iia ion ElA ation Ne ❑ Repair/Replace ❑ Demolition Description of Work: 1, Specify color of color thru tile: g Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ ( W (Revised02/4/2014) TOTAL FEE NOW DUE $ `06.0.0 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address t, City Zip State w A n dV�a Zi D!Is 1A Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signaturear —� OWNER or AGENT OT The fo oing instrument was acknowledged before me this lay of �� 20 ��, by o is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: MY COMMISSION # GG 136575 EXPIRES: August 21, 2021 Bonded Thru Notary public Underwriters as Signature Oe,( CONTRACTOR The for ing instrument was acknowledged before me this day of 4t -J20 by is personally known to me or who As produced as identification and who did take an oath. NOTARY PUBLIC: Print: — '•�'� Seal: * t r = MAR LA DE BRUZOS ,. My COMMISSION # GG 136575 EXPIRES: August 21, 2021 D�KQ.•• Bonded Thn Notary Public urwian i#— ******************************** *************************************** APPROVED BY L ( Plans Examiner Structural Review (Revised02/24/2014) �✓, //Z/�/—Lzoning Clerk CANCELLED-iami Shores Village -mss► Public Works Department O� (305)795-2210 Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: T� t �� Name of ADDlicant (if utilitv see below): c 1 Je J01A.1-Ir Owner off the following described property: Legal Description: Lot Block Subdivision Folio #;I i Address: Ni UTILITY NAME: Qualifier/Authc City: I %_ _ - ta I ZIP: Telephone: -266 Email: e State Certification or Registration #: Certcate of Competency # o3 CONTRACTOR NAME:lil4d� Qualifier/Authorized ge t: Addre s: City: L State: ZIP: Telephone: Email: State Certification or Registration #: Certificat%a--of Competency #: Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way: Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: � 'J✓.r--.w.. Address: City:. �;- State: )' ZIP: Telephones F 'Email: ' Registration#: - - Value of Work for this Permit: $ Q OCA Square/Lineal Footage of Work: SOO J *****Fees***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning$ Bond $ (if required) Total Fee Now Due $ 0' y G� r Bonding Company's Name (if applicable): Bonding Company's Address: City: State: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way and installations as indicated. l certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a public works permit with an estimated value exceeding $2,500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to the attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the public works permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. Signature ' � " e -e v " Applicant or Authorized Agent The foregoing as acknowledged efore me t4' day of In 20by E? who is personally known to me or who has produced as identification. N01 Sign Prin SEA' Signature I �� J �, Company/Utility Agent The foregoi 'nstrum as acknowledge efore me thi y f C.L 20, by \ who is personal) nown to me or wh ha oduced as identification. NOTANY PUBLIC: Sign: Print- SEA] rint: SEA Y'?'.,, COMMISSION # GG 136515 «:lS,pwgust21,2021 1I1N Public Utlderxtl 2017-04-15 APPROVED BY: t ) Public Works Director, or Designee 2017-04-15 DO CUTYENT COVER PAGE For those dDDUMMtS not providing the ta;Tcdred 3 x 3 inch spam on the first page, this cover pap must be attached. Aa tachffd- Aa additional recording fee for this page must be rem-iLLtdi D o cumene Title: (Mortgage, Deed, Etc.) Re -tam D o r-umBni To Prepared By: o'� i li�lll ��I�� ��1�� I��I� fl��� I{lli ��11� ��II f�� CFN 2019R0032370 OR BK 31242 Fss 3934-3935 (N'ss) HAR'VEY R.0 CLERK OF C._0UR_T J± - T � 1�1 I.- D (4. L� 0 U 1 1 H 4TY? FLORIDi L- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (Spa= ahoyet-aS JjDETrs-mrytd fQrmc:0r[fmg c)E5re Lism) 6w oin- ale 2 s2o (cf) On all ... dDc;=mtpTrpsi d to be recorded -inthr public rmx& of any roudy-, a 3-in-ab7 --incli3pace ai ffie -Eop #glit-hamcl camEr onthr fi-stpagt and a. I -inch b -y 3 -+TiclaslDLcea±tfieiopEm#i.-hzncic ogjvpy onp;­li sib se Tozatpa-ge shallbr,15ftbhzk aiaL_mt_-rYcdfbr use by th't dry of court CtfVK 04 GOD WE -YJCT 155 Rev. D8118 Clerk's web address, wwwmiaml-dadeclar 'DR P -K 31292 PG. 3935 LAST PAGE Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) JOCA( F V0 k'6YOv�Q hereinafter ref rred to as the owner of the following described property (address): .�•(� Ci' I St Legal Description Lot Block Subdivision Folio # ,. Requests permission to install (describe work): P 01 C�P W4 Within the public right of way of (address) IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above-mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). Signat ,/_--34 -FcwtAvtb - Owner or Agent .The fo egoinstrume t was�knowledged before me this jb day of Q 1201 by i ersonally known to wefgun—dayDADE a identification and who did take an oath. o6g�f1+.iQIM��of/ "��� NOTARYPUBLIC: KNl s '1�_ • • WA.D. 20 WITNE y hand nd al Seal. HARVEY UVIN, ER rCitO and tents MARIA DEBRUZOS ;. MY COMMISSION # GG 136575 EXPIRES: August 21, 2021 of F ;°."•' Bonded ThN Notary Public Undenvtiters